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fMEwryn�n �PP��CATION FG .I . � ���,�„ <br /> «r�f CONSTRU'TTION O <br /> everett PERM <br /> BUILDING DEPARTMENT <br /> 259•eB10 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMB�NATION ❑ BUILDING ❑ MECHANICAL O PLUMBINO ❑ SIGN <br /> ny���Eq M�IL�ODRE9S CIiY ZIC FMONE <br /> L,� Q,J w, /1Y� /LLQK CUPRa7T 98a� / asB- �� o / <br /> CNrtEC10ROk5ipNEN M�II�DDRES9 CIfY Iln PMONC <br /> r <br /> /L� L.Nt ors��.,nl �/�3o E, T,;..,e.�t �;rcRo. cc,Nr�7 18s.�6 Ja/. 1i9S� FiPc� [0� i�7dc <br /> I 0l�iER�LLONiNeCiO� M�IL�ODRElS ��n' =�P OHONE �iLEN9E• <br /> \`bfGN�HiULCON���Lf011 M�IL�D0111�� CItY 21P PIIOM� LIC[HpC• <br /> T <br />� VIUMlM�CONIR�CfOR MML�DOHE9H CITY IiP fqONE UCENA[ • <br /> CL�SS Of WORY <br /> ❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION � WOODSTOVE/FRPL.INSERT ❑ 91lltCIt1C AeLUC^"9N <br /> v�lwnoa or woA�051 O����EnuLS PLU9 UAOM <br /> / �6�0 <br /> DFSLniBEwOPs—T <br /> ;vs�/1 t c P[ ;.v.r..c .F s ;,� i ' N t .iv�Z <br /> use or ew�ort+c � I HEFEBY CERTIFY THAT I HAVE READ AND E%AI.IINED THIS AP• <br /> S�� "`�9L Q ��"� � � PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.�LI <br /> LW4DESCRIP11pNO�pROPERfV13NOWNBELOWOfl�1 GNfOURCOP1E91 pqOVISIONSOFLAWSANDORDINANCESGOVERNINOTHISTVPE <br /> OF WORK WILL BE COAiPLETED WITH WHETHER SPECIFIED HERE• <br />� w�—noc�_or INORNOT.THEORANTINOOFAPERMITDOEBNOTPRESUMETO <br /> GIVE AUTHORIIY TO VIOIATE OR CANCEL THE PROVISIONS OF <br /> ANV OTHER STATE JR LOCAL LAW REt3ULATIN6 CON3TRUCTION <br /> OR THE PERFORMANCE OF CONSTR'�CTION. , <br /> SIONAIUREOFCONTR11CiORORAUiMORqED/tGENT D�TE <br /> X - '� �2�1� /2 , i� 87 <br /> PPOJECT�OORESS �PPIIC�Ni. GIfY8U51NE54L�CENSENO C <br /> � �o APt�e � l6.te1 <br /> PLUMSINO MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYVE OF ECUIPMENT FE[ <br /> WIITER CLOSET�TOIIET� A/C—AMNOLO UNITS—H.P. <br /> BATMTUB REFRI6ER�TION UNITS—H.P.EA. <br /> UV�TOPY(WASM BASIN� BOILERS—B.T.U./N P. <br /> SMOWER GAS FIRED A.C.UNITS—B.T.U. <br /> KITCMEN SINK S OISP. FOACED 111R SYSTEMS—B.T.U. M EA. <br /> OISMW�SNER WALLNEATERS—B.T.U. M <br /> UUNDRV TR�Y UNIT HEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> UPINAI CLOTMES ORYEPS <br /> DRINKING FOUNTAIN VENTIUTIUN FAN <br /> FLOOR ONAIN RANOE HOOD <br /> BACNFLOW PREVENTERS WATER NEAiEH <br /> ROOF DRAINS—FAINLEADERS WOOD STOVE <br /> SINN�SERVICE—BRR.ETC� METAL FIREPLACE 8 CHIMNEY <br /> FIRE%ACE INSERi <br /> MEATPUMP <br /> CI1S PIPIN� <br /> E%HRUSTFAN <br /> !U!TOTAL s eue ror�u. <br /> PERMIT f PfRMIi <br /> T0�I1L FEE f TOTAL FEE <br /> �uUNr SEIB�ct�� - aE�R SEiB�Ce SIDE SEIB�CK �AN CHECN NUMBER FEE RECEIPT NO. <br /> ust eoHc io��ne� y�CANT SITE FEES VALUATION FEE <br /> OVES ONO <br /> BUILDING S <br /> IVPEOFLONSt OCCVP�HCYGPOUP NO.OFDWELLINUUNI7S <br /> - PLUMBING <br /> SiZE O�BI OG ND OF STORIE9 M�X.004 LOAD <br /> ' MECHANICAL <br /> OTHER <br /> FIRE SPRINKLERS REOUIRED ❑ YFS ❑NO STATE BUILDING SURCHARGE <br /> STATEENERGVSURCHnRGE <br /> PI-0+I�CLIIONaCf. B� �UNSCNEGNEDBY ��Pq FORISSU�NGEBY <br /> PUBLIC WORK9 <br /> TOTAL <br /> PROPERTY OWNERS ARE RESPONSIBLE i'OR DETERMININO ALL <br /> PROPERN LINE IOCATIONS AND RELATED EASEMENTS. <br />